Summer 2021 (Volume 31, Number 2)
2021 Practice Reflection Award: Stephanie Gottheil, MD, FRCPC
Rheum Service: Improving Virtual Care During COVID-19
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During COVID-19, patients require
timely access to rheumatologists
while physical distancing. As a
new community clinic that opened in
April 2020, we faced a unique challenge:
unlike our colleagues with many long-term
follow ups, all our patients were new
consults requiring initial assessments.
We saw this as an opportunity to design a
comprehensive virtual care process from
scratch.
Our virtual pathway had three phases:
pre-visit, visit, and post-visit. In the
pre-visit phase, we emailed appointment
details with fillable forms (using Accuro/
Ocean), and we offered training for video
calls. In the visit phase, we used the Doxy.Me platform to connect with patients over video. In the
post-visit phase, we offered patients a digital consultation
report and access to secure physician messaging.
After receiving initial feedback, we refined our process
by decreasing the frequency of email reminders and adding
backup video platforms. Initially, patients were only
offered a video test if they expressed concerns about using
the technology. After studying our process, we increased
pre-call testing by offering one-on-one tests for all patients,
and finally switched to a self-guided test with one-on-one support if needed.
Between April-October 2020, 413/485 (85%) patients
had an initial consultation by video. To measure patient
satisfaction, we asked patients whether they would like to
have another video appointment in the future using our
anonymous survey. Out of 162 respondents, 62% said “yes”;
33% were “not sure”; and 6% said “no.” We also wanted
to measure if video calls resulted in accurate diagnoses.
Out of 262 patients who had a subsequent in-person appointment,
232 (87%) maintained the same diagnosis from
their initial video call, suggesting reasonable diagnostic
accuracy.
An important process measure was the effectiveness
of our pre-call video testing. Only 34/413 (8%) of video
consults had technical difficulties resulting in a switch to
telephone. Of these, 28 (82%) had not completed a pre-call
video test, suggesting that the tests were effective.
While opening a new practice during COVID-19 was
certainly a challenge, it allowed us to design and implement
a new clinical workflow for virtual
care. Based on the success of this project,
we plan to continue offering video visits
to our patients even after COVID-19 restrictions
have been lifted.
Stephanie Gottheil, MD, FRCPC
Rheumatologist,
London Rheumatology
Adjunct Professor of Rheumatology,
Western University
London, Ontario
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